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Curriculum
Curriculum
for Basic Physician Training
This
section covers the curriculum outlined below under General Objectives and
the Core Adult Internal Medicine Disciplines with which all trainees should
be familiar.
This curriculum is a conceptual outline for the acquisition
of core knowledge, skills, and attitudes and should not be regarded as all-inclusive,
prescriptive or mandatory.
The training program and the examination must
take into account the evolving nature of medicine as a discipline, and the changes
in technology and practice that impact upon it.
General
Objectives
The overall aim of basic physician training is to develop
a combination of knowledge and understanding, skills and attitudes, from which
are formed the competencies which are a foundation for advanced training and for
lifetime practice as a physician in adult internal medicine.
These competencies
cannot be defined simply as a list of factual knowledge or practical skills, as
many of the objectives are related to abstract qualities which are attitudinal.
However, within the following objectives, a high level of factual knowledge is
required to enable appropriate competency to be achieved.
The following
general objectives of basic physician training are outlined in broad detail.
Objectives
Relating to Knowledge and Understanding - A sound knowledge of
normal
human biology and its alteration in acute and chronic disease.
- Detailed knowledge of the investigation and management of acute and chronic
medical disorders.
- An understanding of the impact of illness on a
patient's life.
- Knowledge of hospital and community based resources
available for patients and caregivers.
- An appreciation of ethical
considerations in interactions with patients, caregivers and colleagues.
- An
understanding of scientific methods, including clinical trial design, basic statistical
techniques and outcome assessments.
- The ability to assess new medical
knowledge and its application.
- Knowledge of QA procedures.
Objectives Relating
to to Skills
The following skills are essential to consultant physician
practice in adult internal medicine and its subspecialties. They are further developed
during advanced training.
Clinical Skills
- General Verbal Communication Skills
These include the
establishment of professional relationships with patients and their relatives
or caregivers, in order to obtain a history from the patient; conduct a physical
examination; and provide appropriate management of inpatients with multiple medical
problems. This includes the ability to judge which condition(s) take priority
over others with respect to investigation and management. Verbal presentation
using appropriate language at the bedside, in a seminar or classroom is also important
and to know when and how to communicate urgently with a general practitioner by
telephone. In summary, it is the ability to communicate clearly, considerately
and sensitively with patients, relatives, other health professionals and the public.
- General Physical Examination Skills
The physical examination
of all systems should include: - the ability to interpret physical signs;
and
- the ability to perform an accurate physical and mental state
examination in complex medical problems, often involving multiple systems.
- General Written Communication Skills
The patient's
problems should be clearly, concisely and accurately recorded, and regularly updated.
The trainees should be able to form and record a clear management plan after the
initial history and clinical examination. It is also important to learn how to
write a complete discharge summary and a competent letter for outpatients and
a general practitioner.
- Patient Management Skills
These
include problem solving; problem identification; analysis and management by the
use of appropriate resources; interpretation of laboratory results; and the importance
of avoiding unnecessary investigation and hospitalisation. This also includes
the ability to prioritise different problems within a specified time frame. All
this should be in concert with the patient, the patient's caregivers and other
health professionals and should take into consideration the risks and benefits
of the treatment. The ability to interpret and integrate the history and examination
findings and arrive at an appropriate diagnosis or differential diagnosis.
- Skills in Relation to Medical Ethics
These relate to ethical
issues, including confidentiality and confidential computerised record keeping,
ethics and medico-legal aspects of informed consent. Ethical issues are of considerable
importance, especially with respect to the elderly and mentally incapable.
Professional Etiquette - The ability to
handle complaints including self-criticism or criticism by colleagues or patients.
- Understanding the importance of a second opinion and advice from other
health professionals.
Management of Terminal
Illness and Bereavement - Care of the dying.
- Conveying
bad news, answering questions from patients and relatives and handling the emotional
aspects.
- Making decisions concerning resuscitation.
- Immediate
management of bereavement.
- Requests for organ donation.
Technical Skills - Venepuncture, venesection
and cannulation and intravenous infusion.
- Arterial access including
blood gas sampling.
- Injection techniques.
- Cardiopulmonary
resuscitation.
- Urinary catheterisation, male and female, and urine
analysis and microscopy.
- Lumbar puncture.
- Insertion
of chest tubes.
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